The ultrasonographic correlates of carpal tunnel syndrome in patients with normal electrodiagnostic tests.

PURPOSE: The diagnosis of carpal tunnel syndrome (CTS) is established by electrodiagnostic testing (EDT). Nonetheless, in a portion of patients complaining of the typical signs and symptoms of CTS, the EDT is negative, and yet no paraclinical tool has been acknowledged for confirming the diagnosis. The aim of this study was to investigate the value of ultrasound imaging in diagnosing clinically suspicious patients with normal EDT findings. MATERIALS AND METHODS: Thirty-four patients, with clinical evidence of CTS but without abnormal findings on electromyography, and 41 healthy controls were enrolled. Ultrasonography was performed in all participants, and cross-sectional area (CSA), hypoechogenicity and hypervascularity of the median nerve were evaluated. Multivariate logistic regression analysis was used to formulate a prediction model for CTS. RESULTS: CSA of the median nerve in the wrist and wrist-to-forearm ratio were significantly higher in patients compared with controls. Patients had significantly higher hypoechogenicity [odds ratio (OR) 4.317; 95% confidence interval (CI) 1.23-15.11) and hypervascularity (OR 5.004,; 95% CI 1.02-21.15) in the median nerve. Clinical evidence of CTS was predicted using a model comprising three ultrasonographic determinant factors, including hypoechogenicity, hypervascularity and wrist CSA of the median nerve. The probability of clinical evidence of CTS in a person with one, two, or three ultrasonographic signs of CTS was estimated to be 35%, 70%, and 90%, respectively. CONCLUSIONS: Ultrasound imaging is a useful technique in diagnosing CTS patients when EDT results are not confirmatory and the patient is suspected of having neuropathy.

Pseudoaneurysm of a high origin radial artery treated by ultrasound-guided compression.

A high origin of the radial artery from the brachial artery is the most frequently encountered arterial anomaly in an upper extremity, and is reported in seven percent of individuals. This variant is vulnerable to injury because of its more superficial location. A 59-year-old man developed a pseudoaneurysm following the inadvertent cannulation of a high origin radial artery. We report the successful treatment of the pseudoaneurysm by ultrasound-guided compression. Ultrasound-guided compression is an available and simple method for the repair of arterial pseudoaneurysms, and delayed complete thrombosis can be expected even if a residual flow remains after the initial compression.